Written By Donna Engle
For nearly a decade, a hospital emergency room was the only health care Melissa Gilbert had. Without insurance, the 26-year old Mount Airy woman could not afford to pay a private physician. Every few months, when she needed a blood test to monitor her diabetes or prescription refills for the two types of insulin she takes daily, she would have to go to the emergency room.
Last fall, Gilbert began receiving medical care from Access Carroll, a Westminster health care program that is the “family doctor” for approximately 1,400 uninsured, low-income county residents.
For Gilbert, it was a happy change. Whether she drove north to the Carroll Hospital Center emergency room or south to Montgomery General Hospital in Olney, she faced long hours waiting. Under the typical emergency room triage system, where patients with immediately life-threatening illness or injury are treated first, those with urgent but not life-threatening needs second, and less urgent cases third, Gilbert fell into the third category.
“You’re not bleeding or dying, so you had to spend a day in the ER, and with two small children, that was a mess,” Gilbert said. Her son is 5 years old, her daughter, 2.
Gilbert’s part-time job does not provide health insurance. Her fianc’s employer offers it, but the couple cannot afford the payroll deduction.
John F. Smith Jr., who lives in the Union Bridge area, lost his health insurance five years ago when the company where he had worked for 42 years folded. For a time, he did without the medications he needs for high cholesterol and high blood pressure. Then his sister steered him to Mission of Mercy (MOM), a mobile health care clinic that brings basic health care to nine communities in Carroll and Frederick Counties and Adams County, Pennsylvania.
“If it wouldn’t be for these people, I couldn’t afford to get medicines,” Smith said. He has found part-time work, but does not have access to health insurance. He visits MOM every two to three months for blood pressure monitoring and the medications that the clinic dispenses free to patients. He has not used the emergency room.
Gilbert and Smith are not alone in not having health insurance. The National Coalition on Health Care reports that nearly 47 million Americans, 16 percent of the population, lack insurance. In Carroll County, there are approximately 15,000 uninsured – 9 percent of the area’s population – a study by the Maryland Family Health Administration found. Half the uninsured Carroll residents reported that there was a time in the previous 12 months when they could not afford to see a doctor.
Many people without health insurance turn to hospital emergency departments for basic health care. The American Hospital Association found that nearly half of the nation’s emergency rooms were at or over capacity in 2005.
The Maryland Hospital Association attributes emergency room crunches across the state to patients having to wait in emergency rooms for admission to the hospital because beds are unavailable; limited hours at community health centers and private physicians’ offices; slow diagnoses because of staff shortages in laboratories and imaging departments, and people bypassing neighborhood urgent care centers to take minor ailments to emergency rooms.
The nearly 24,000 Maryland residents who visited emergency rooms in 2006 spent an average 4 hours, 37 minutes there, according to a national survey. Only five states have longer emergency room waiting times. Hospitals are trying to address long wait times. At Johns Hopkins Bayview Medical Center in Baltimore, an independent urgent care center recently opened on the hospital campus to treat non-life-threatening illnesses and diseases. Montgomery General Hospital has broken ground for an expansion that will double the size of its emergency room, to accommodate 35,000 patient visits a year.
A Carroll Hospital Center spokesperson said that the number of emergency visits to their ER has increased by 16 percent over the past five years. Last year the hospital saw more than 50,000 patient visits to the emergency department. As a result, a hospital official said, its physicians and other clinical staff have put in place measures, including a dedicated imaging suite and an advanced triage system, designed to shorten turnaround times.
Neither Access Carroll nor MOM was started in an effort to reduce waiting times at the local emergency department. But both may have had that effect by offering alternative care for non-life-threatening illness or injury and by providing early treatment so that illness or injury does not become so severe that patients require emergency care.
Access Carroll grew out of a 1995-1996 community health needs assessment by nine Maryland hospitals, according to Patricia “Tricia” Supik, executive director and CEO of Partnership for a Healthier Carroll County, Inc.
When public spirited Carroll Countians learned that the county had too few uninsured residents to qualify for a federally-aided clinic, they sought help from Carroll Hospital Center and the Carroll County Health Department. Under the leadership of the two agencies, Access Carroll opened in 2005 in Locust Lane, Westminster, to serve uninsured low-income county residents. It relies heavily on volunteer physicians and nurses, all determined that no patient should ever receive second-class treatment.
“Since the day I’ve been going there, and I just kind of showed up at the door,” said Gilbert, “all the women have bent over backwards to make sure I have everything I need . . .They’re just amazing. They do it without being judgmental, looking at me like I’m a bad person because I’m low-income.”
Patient visits to Access Carroll have increased exponentially since the office opened, from 596 in the first year to 4,477 in fiscal year 2007.
The typical Access Carroll patient is a white female who suffers from a chronic disease such as mental illness, diabetes, high blood pressure, pain syndrome or lung disease. Women outnumber men about 2.5 to 1. Eighty-five percent of patients are white, 7 percent African American and 5 percent Hispanic. More than 75 percent have chronic diseases.
Many hold jobs. Tammy Black, an RN who is executive director of Access Carroll, reported that the office’s recent addition of evening hours on Wednesdays filled quickly. “The doctor is booked. The evening hours help because most of our patients work, some at several jobs, and when they don’t work, they don’t get paid,” said Black.
MOM was founded in 1994 when Dr. Gianna Talone-Sullivan, a pharmacist, was inspired to provide free health care to those who could not afford to see a private doctor. She started a mobile van clinic in Arizona, and expanded to Maryland, Pennsylvania and Texas. The mission relies on volunteer medical professionals whose work is supplemented by donated laboratory, diagnostic, x-ray services and surgery at local hospitals, including Carroll Hospital Center.
MOM is unique in providing free dental care at most of its sites in Carroll and Frederick Counties. Demand is high for the limited services – extractions and fillings – that the volunteer dentists are able to provide. With dental care offered first come, first served, people start lining up at 2 a.m. on clinic days, said Linda M. Ryan, executive director of MOM.
“Dental care is such a huge problem in the U.S. There’s just nowhere to go. Even some emergency rooms will give you antibiotics, but not dental care,” Ryan said. It is not uncommon for MOM’s volunteer dentists to see patients who haven’t had dental care for 25 years, she said.
The MOM van recorded 2,973 patient visits at its three Carroll County sites in the fiscal year that ended September 30, 2007, a decrease of 515 from the previous year. Staff members attribute the decrease to the number of patients suffering chronic health care problems that require more physician time.
MOM accepts no government funding and does not require proof of income. “We don’t take any government support because we don’t feel we could restore dignity by asking people to prove poverty,” Ryan said.
The typical MOM patient is a white adult female who suffers from a chronic disease. Nearly half the patients are women; about one-third are men (numbers do not add up to 100 percent because the gender of children and the elderly is not identified). Two in five are racial minorities. Ninety percent have no health insurance, and 70 percent suffer from a chronic illness.
Carroll residents with specific medical needs can get care through the Carroll County Health Department. The department also works to prevent chronic diseases by offering body fat and cholesterol screenings and blood pressure tests at health fairs and farmers markets. But the Health Department cannot provide the primary care that would help patients bypass the emergency room, said Dr. Elizabeth Ruff, deputy health officer.
The Health Department addresses public health issues with family planning services for women of reproductive age, breast and cervical cancer screenings, a sexually transmitted disease clinic, children’s immunizations, adult flu vaccines, treatment for people who have tested positive for tuberculosis, HIV testing and counseling and a clinic for HIV-positive individuals. Some services are available based on income, some carry fees and some are free.
